It is a process of encapsulating bile within the abdomen, which is contained or surrounded by epithelial cells. It appears after a laceration in the bile duct.
These are groups of tightly compressed cells that form an intra-abdominal tissue capable of creating adhesions on the surfaces of biliary organs and tissues.
In this way, it is possible to avoid, through encapsulation, the bile reaching the rest of the peritoneal cavity.
The billion can be located intra or extrahepatic.
The billion is also known as a biliary cyst. These cysts can be presented to any person for several reasons.
The patients who present a higher risk of pathology underwent surgery such as the cholecystectomy procedure or liver damage in their medical history. A cholecystectomy is a surgical procedure that is done to remove the gallbladder.
Patients subjected to this type of intervention are at risk and are continuously monitored and controlled.
All this is to identify any signs of post-surgical complications before more severe pathologies that could even cause death.
Because they accumulate bile within your abdomen, there are several common reasons for you to develop a billion. It could be due to problems with the bile duct or damage to your liver. It can also occur due to trauma or an iatrogenic injury.
Bile is a liquid produced in the liver and plays a role in your digestive process. The bile duct is what transports bile.
The symptoms associated with this pathology are very variable and present themselves in very different ways in each patient, being able to generalize with the following:
- Symptoms of sensitivity or abdominal pain may occur.
- You may experience confusion and fever; fever is not a usual symptom but is associated with infectious diseases.
- It is possible to experience pain in the right hypochondrium.
- There may be abdominal distension, accompanied by flatulence and a feeling of fullness.
- Jaundice is commonly observed.
Usually, the billions are in the right hypochondrium. However, they may be located in the left hypochondrium due to the migration of bile.
Subphrenic and subhepatic bile collections are the most common, those associated with trauma and surgery are less frequent, and spontaneous subcapsular hepatic dilemmas rarely occur.
A billion are diagnosed using ultrasound images (ultrasound) and computerized axial tomography (CT).
To confirm the diagnosis, needle aspiration is performed.
Now, if the encapsulation has a deposit of bile, it will appear in the images. In the sample, a greenish liquid will be observed (bile), but its color can be affected by the presence of blood or the exudate product of the infection.
To carry out the differential diagnosis of the billion, other similar pathologies must be taken into account, within which we have:
- Seroma: Accumulation of serum, lymph, and liquid fat.
- Lymphocele: Cystic structure produced by a lesion of the lymphatic vessels.
- Hematoma: Accumulation of blood by rupture of capillaries.
- Hepatic abscess: Collection of pus located in the liver, resulting from an infectious process with the destruction of the hepatic stroma and parenchyma.
- Pseudocyst and hepatic cyst: An encapsulation of fluid but not communicating with the bile duct, the wall of the well-defined capsule is observed in the CT scan.
It is essential in the diagnosis and the appreciation of the physical examination to take into account the findings of the biopsy of the content of the aspiration, the results presented in the imaging studies, and the location of the lesion.
Because these tests allow differential diagnosis and distinguish billions from other very similar pathologies.
In a billion that presents a small size, the treatment is often very conservative since, usually in these cases, the pathology disappears when the body reabsorbs the bile content encapsulated in the billion.
If, on the contrary, it is a giant lipoma, the ideal is to perform drainage.
This procedure can be surgical or percutaneous and is performed through a pigtail catheter using endoscopic sphincterotomy or endoscopic nasociliary drainage.